When assessing whether multiple carious teeth and poor oral hygiene are an indicator of general neglect, the dentist should focus on assessing the impact of dental disease on the individual child (see case study). Severe dental disease can cause:
- toothache
- disturbed sleep
- difficulty eating or change in food preferences
- absence from school
and may put a child at risk of:
- being teased because of poor dental appearance
- needing repeated antibiotics
- repeated general anaesthetic extractions
- severe infection.
A note of caution
Care should be taken to consider other relevant factors and to resist erroneous assumptions (such as that the number of carious teeth correlates with the severity of the problem) for the following reasons:
- the multi-factorial causation of dental caries
- variation in individual susceptibility to dental disease
- differences in the treatment dentists provide (for example, whether they choose to manage caries in primary teeth by monitoring or restoration or extraction)
- inequalities in dental health (for example, regional or social class differences in caries experience)
- inequalities in access to dental services and treatment.
The authors suggest that, in order to avoid misunderstanding, the term dental neglect should be reserved for situations where there is a failure to respond to a known significant dental problem. This is an area that requires sensitivity and clinical judgment. There is a need for further research to inform the dental team in making these decisions and in managing dental neglect.
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